Carretero-Gómez Juana, Carrasco-Sánchez Francisco Javier, Fernández-Rodríguez José María, Casado-Escribano Pedro, Miramontes-González José Pablo, Seguí-Ripoll José Miguel, Ena Javier, Arévalo-Lorido José Carlos
Servicio de Medicina Interna, Hospital Universitario de Badajoz, Badajoz, Spain.
Servicio de Medicina Interna, Hospital Universitario Juan Ramón Jimenez, Huelva, Spain.
Rev Clin Esp (Barc). 2023 Mar;223(3):134-143. doi: 10.1016/j.rceng.2022.12.001. Epub 2022 Dec 19.
This work aims to assess the effect of weekly subcutaneous semaglutide on biomarkers of metabolic-associated fatty liver disease (MAFLD), namely the hepatic steatosis index (HSI) and the fibrosis-4 (FIB-4) index, at 24 weeks in outpatients attended to in internal medicine departments.
This study analyzed patients in an ongoing, multicenter, prospective, pre-post, uncontrolled cohort registry that enrolls unique, consecutive patients with type 2 diabetes treated with weekly subcutaneous semaglutide. Steatosis/fibrosis were determined by HSI (<30 ruled out, >36 steatosis) and FIB-4 (<1.3 ruled out, >2.67 fibrosis), respectively.
The sample included 213 patients (46.9% women) with a median age of 64 (19) years. The median baseline body mass index and weight were 36.1 (8.4) kg/m and 98 (26.9) kg, respectively. A total of 99.9% had HSI values indicating steatosis, with a mean HSI of 47.9 (8.2). Additionally, 10.8% had fibrosis (FIB-4 > 2.67) and 42.72% had values in intermediate ranges (FIB-4 1.3-2.67). At 24 weeks, there was a significant reduction in HSI (-2.36 (95%CI 1.83-2.9) p < 0.00001) and FIB-4 (-0.075 (95%CI 0.015-0.14) p < 0.016), mainly related to declines in body weight, triglyceride levels, insulin resistance (estimated by the triglyceride-glucose index), and liver enzymes.
These results show that weekly subcutaneous semaglutide had a beneficial effect on liver steatosis that went beyond glucose control. Its effects were mainly related to weight loss, a decline in biomarkers, and improvements in insulin sensitivity. For many patients, early detection is essential for improving MAFLD outcomes and may allow for selecting the most efficient treatment options.
本研究旨在评估每周一次皮下注射司美格鲁肽对内科门诊患者代谢相关脂肪性肝病（MAFLD）生物标志物的影响，即肝脂肪变性指数（HSI）和纤维化-4（FIB-4）指数，观察时间为24周。
本研究分析了一项正在进行的多中心、前瞻性、前后对照、非对照队列登记研究中的患者，该研究纳入了接受每周一次皮下注射司美格鲁肽治疗的2型糖尿病患者，且患者均为独特的连续病例。分别通过HSI（<30排除脂肪变性，>36为脂肪变性）和FIB-4（<1.3排除纤维化，>2.67为纤维化）来确定脂肪变性/纤维化情况。
样本包括213例患者（46.9%为女性），中位年龄为64（19）岁。基线时体重指数和体重的中位数分别为36.1（8.4）kg/m²和98（26.9）kg。共有99.9%的患者HSI值表明存在脂肪变性，平均HSI为47.9（8.2）。此外，10.8%的患者有纤维化（FIB-4>2.67），42.72%的患者处于中间范围（FIB-4 1.3 - 2.67）。在24周时，HSI（-2.36（95%CI 1.83 - 2.9）p<0.00001）和FIB-4（-0.075（95%CI 0.015 - 0.14）p<0.016）显著降低，这主要与体重、甘油三酯水平、胰岛素抵抗（通过甘油三酯-葡萄糖指数估算）和肝酶的下降有关。
这些结果表明，每周一次皮下注射司美格鲁肽对肝脏脂肪变性有有益作用，且超出了血糖控制的范畴。其作用主要与体重减轻、生物标志物下降以及胰岛素敏感性改善有关。对许多患者而言，早期检测对于改善MAFLD的预后至关重要，并且可能有助于选择最有效的治疗方案。
